Provider Demographics
NPI:1205360229
Name:COLLORD, LESLIE EILENE (LMHC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:EILENE
Last Name:COLLORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 OFFICERS ROW
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3849
Mailing Address - Country:US
Mailing Address - Phone:503-389-0742
Mailing Address - Fax:
Practice Address - Street 1:955 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3849
Practice Address - Country:US
Practice Address - Phone:503-389-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-70701101YP2500X
WALH60991090101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2099439Medicaid
OR1699745794Medicaid